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Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials.
World J Surg. 2016 Jun; 40(6):1509-19.WJ

Abstract

OBJECTIVE

The purpose of this article is to systematically analyse the randomized, controlled trials (RCTs) comparing Ferguson or closed haemorrhoidectomy (CH) versus open haemorrhoidectomy (OH) or Milligan-Morgan haemorrhoidectomy in the management of haemorrhoidal disease (HD).

METHODS

RCTs on the effectiveness of CH and OH in the management of HD were analysed systematically using RevMan(®), and combined outcome was expressed as odds ratio (OR) and standardized mean difference.

RESULTS

Eleven CRTs encompassing 1326 patients were analysed systematically. There was significant heterogeneity among included trials. Therefore, in the random effects model, CH was associated with a reduced post-operative pain (SMD, -0.36; 95 % CI, -0.64, -0.07; z = 2.45; p = 0.01), faster wound healing (OR, 0.08; 95 % CI, 0.02, 0.24; z = 4.33; p < 0.0001), lesser risk of post-operative bleeding (OR, 0.50; 95 % CI, 0.27, 0.91; z = 2.27; p < 0.02) and prolonged duration of operation (SMD, 6.10; 95 % CI, 3.21, 8.98; z = 4.13; p < 0.0001). But the variables such as pain on defecation (SMD, -0.33; 95 % CI, -0.68, 0.03; z = 1.82; p = 0.07), length of hospital stay, post-operative complications, HD recurrence and risk of surgical site infection were similar in both groups.

CONCLUSION

CH has clinically measurable advantages over OH in terms of reduced post-operative pain, lower risk of post-operative bleeding and faster wound healing.

Authors+Show Affiliations

Department of General & Colorectal Surgery, NHS Foundation Trust, Queen Elizabeth Hospital, King's Lynn, Gayton Road, King's Lynn, Norfolk, PE30 4ET, UK.Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals, NHS Foundation Trust, Worthing Hospital, Washington Suite, North Wing, Worthing, West Sussex, BN11 2DH, UK. surgeon1wrh@hotmail.com.Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals, NHS Foundation Trust, Worthing Hospital, Washington Suite, North Wing, Worthing, West Sussex, BN11 2DH, UK.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

26813541

Citation

Bhatti, Muhammad I., et al. "Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): a Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials." World Journal of Surgery, vol. 40, no. 6, 2016, pp. 1509-19.
Bhatti MI, Sajid MS, Baig MK. Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials. World J Surg. 2016;40(6):1509-19.
Bhatti, M. I., Sajid, M. S., & Baig, M. K. (2016). Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials. World Journal of Surgery, 40(6), 1509-19. https://doi.org/10.1007/s00268-016-3419-z
Bhatti MI, Sajid MS, Baig MK. Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): a Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials. World J Surg. 2016;40(6):1509-19. PubMed PMID: 26813541.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials. AU - Bhatti,Muhammad I, AU - Sajid,Muhammad Shafique, AU - Baig,Mirza K, PY - 2016/1/28/entrez PY - 2016/1/28/pubmed PY - 2017/2/9/medline SP - 1509 EP - 19 JF - World journal of surgery JO - World J Surg VL - 40 IS - 6 N2 - OBJECTIVE: The purpose of this article is to systematically analyse the randomized, controlled trials (RCTs) comparing Ferguson or closed haemorrhoidectomy (CH) versus open haemorrhoidectomy (OH) or Milligan-Morgan haemorrhoidectomy in the management of haemorrhoidal disease (HD). METHODS: RCTs on the effectiveness of CH and OH in the management of HD were analysed systematically using RevMan(®), and combined outcome was expressed as odds ratio (OR) and standardized mean difference. RESULTS: Eleven CRTs encompassing 1326 patients were analysed systematically. There was significant heterogeneity among included trials. Therefore, in the random effects model, CH was associated with a reduced post-operative pain (SMD, -0.36; 95 % CI, -0.64, -0.07; z = 2.45; p = 0.01), faster wound healing (OR, 0.08; 95 % CI, 0.02, 0.24; z = 4.33; p < 0.0001), lesser risk of post-operative bleeding (OR, 0.50; 95 % CI, 0.27, 0.91; z = 2.27; p < 0.02) and prolonged duration of operation (SMD, 6.10; 95 % CI, 3.21, 8.98; z = 4.13; p < 0.0001). But the variables such as pain on defecation (SMD, -0.33; 95 % CI, -0.68, 0.03; z = 1.82; p = 0.07), length of hospital stay, post-operative complications, HD recurrence and risk of surgical site infection were similar in both groups. CONCLUSION: CH has clinically measurable advantages over OH in terms of reduced post-operative pain, lower risk of post-operative bleeding and faster wound healing. SN - 1432-2323 UR - https://www.unboundmedicine.com/medline/citation/26813541/Milligan_Morgan__Open__Versus_Ferguson_Haemorrhoidectomy__Closed_:_A_Systematic_Review_and_Meta_Analysis_of_Published_Randomized_Controlled_Trials_ L2 - https://dx.doi.org/10.1007/s00268-016-3419-z DB - PRIME DP - Unbound Medicine ER -